Snoring (cont.)

Siamak N. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

How is it determined if snoring is a medical problem?

People who sleep (or lie awake not sleeping) near a snorer often report signs
that may indicate a more serious problem. Witnessed apnea (stopping breathing)
or gasping can suggest a breathing problem like sleep apnea (see below) or heart
problems. Leg kicking or other jerking movements can indicate a problem such as
periodic limb movement disorder or restless leg syndrome. Referral to a sleep specialist
may be recommended if obstructive sleep apnea, restless leg syndrome, and
periodic limb movement disorder are suspected. Multiple studies have shown that
simple clinical evaluations cannot determine if a person only snores, or if he
or she has a more significant sleep disturbance. Therefore, a sleep study is
often needed to rule out obstructive sleep apnea prior to initiating any
treatments.

If someone's sleep is disrupted because of snoring, the person may also
notice other symptoms. Frequently, people complain of difficulty waking up in
the morning or a feeling of insufficient sleep. They may take daytime naps or
fall asleep during meetings. If sleep disruption is severe, people have fallen
asleep while driving or performing their daily work.

Daytime sleepiness can be estimated with a sleepiness inventory, and a sleep
study can be performed if a sleeping problem is suspected. There are two general
types of sleep studies:

Home sleep study (portable sleep study)

Full sleep study (polysomnography in a laboratory with a technician)

Home sleep study

A home (unattended) sleep study can measure some basic
parameters of sleep and breathing. A pre-test evaluation by a sleep medicine
specialist to determine if home testing is appropriate is recommended. Often,
the home sleep study will include pulse oximetry
(a measurement of the level of oxygen in the blood), a record of movement,
snoring, and apneic (pause in breathing) events. A home study can prove that there are no
sleeping problems or suggest that there may be a problem. Some types of home
sleep studies may monitory blood vessel reactions or tone as well as detecting
respiratory events. Improved technology has expanded the ability to perform
testing in the person's own sleep environment.

If a home sleep study suggests a problem, treatment is often initiated. If
the results are not clear, repeat testing with a full sleep study
(polysomnography) may be performed in a clinic. (For a complete description of
sleep studies, see below).

If the sleepiness inventory and sleep study suggest there are no sleeping or
breathing disorders, a person is diagnosed with primary snoring. Treatment
options then can be discussed.

Epworth Sleepiness Scale

The Epworth Sleepiness Scale is a "test" based on a patient's own report that
establishes the severity of sleepiness. A person rates the likelihood of falling
asleep during specific activities. Using the scale from 0-3 below, patients rank
their risk of dozing in the chart below. (This chart can be printed out and
taken to the doctor.)

0 = Unlikely to fall asleep

1 = Slight risk of falling asleep

2 = Moderate risk of falling asleep

3 = High likelihood of falling asleep

Situation

Risk of Dozing

Sitting and reading

Watching television

Sitting inactive in a public place

As a passenger in a car riding for an hour, no breaks

Lying down to rest in the afternoon

Sitting and talking with someone

Sitting quietly after lunch, without alcohol

In a car, while stopped for a few minutes in traffic

After ranking each category, the total score is calculated. The range is
0-24, with the higher the score the more sleepiness.

Scoring:

0-9 = Average daytime sleepiness

10-15 = Excessive daytime sleepiness

16-24 = Moderate to severe daytime sleepiness

Breaking it down further, excessive daytime sleepiness is greater than 10.
Primary snorers usually have a score less than 10, and individuals with moderate
to severe sleep apnea usually have a score greater than 16. (One woman filled
out the sleepiness scale and had a low score. Sitting in the physician's office,
however, she was falling asleep while waiting. The physician asked her why her
score was so low. She replied, "I don't ever read books, watch TV, or ride in a
car, so the likelihood that I would fall asleep doing those things is very low.")